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sustained lung inflations

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https://www.readbyqxmd.com/read/27881405/effectiveness-of-individualised-lung-recruitment-strategies-at-birth-an-experimental-study-in-preterm-lambs
#1
David G Tingay, Anushi E Rajapaksa, Emanuela Zannin, Prue M Pereira-Fantini, Raffaele Dellacà, Elizabeth Perkins, Cornelis Elroy E Zonneveld, Andy Adler, Don Black, Inez Frerichs, Anna Lavizzari, Magdy Sourial, Bartłomiej Grychtol, Fabio Mosca, Peter G Davis
Respiratory transition at birth involves rapidly clearing fetal lung liquid and preventing efflux back into the lung whilst aeration is established. We have developed a sustained inflation (SIOPT) individualized to volume-response and a dynamic tidal positive end-expiratory pressure (open lung volume, OLV) strategy that both enhance this process. We aimed to compare the effect of each with a group managed with PEEP of 8 cmH2O and no recruitment manoeuvre (No-RM), on gas exchange, lung mechanics, spatiotemporal aeration and lung injury in 127±1d preterm lambs...
November 23, 2016: American Journal of Physiology. Lung Cellular and Molecular Physiology
https://www.readbyqxmd.com/read/27538798/efficacy-of-a-new-technique-intubate-recruit-surfactant-extubate-in-rec-sur-e-in-preterm-neonates-with-respiratory-distress-syndrome-study-protocol-for-a-randomized-controlled-trial
#2
Giovanni Vento, Roberta Pastorino, Luca Boni, Francesco Cota, Virgilio Carnielli, Filip Cools, Carlo Dani, Fabio Mosca, Jane Pillow, Graeme Polglase, Paolo Tagliabue, Anton H van Kaam, Maria Luisa Ventura, Milena Tana, Chiara Tirone, Claudia Aurilia, Alessandra Lio, Cinzia Ricci, Alessandro Gambacorta, Chiara Consigli, Danila D'Onofrio, Camilla Gizzi, Luca Massenzi, Viviana Cardilli, Alessandra Casati, Roberto Bottino, Federica Pontiggia, Elena Ciarmoli, Stefano Martinelli, Laura Ilardi, Mariarosa Colnaghi, Piero Giuseppe Matassa, Valentina Vendettuoli, Paolo Villani, Francesca Fusco, Diego Gazzolo, Alberto Ricotti, Federica Ferrero, Ilaria Stasi, Rosario Magaldi, Gianfranco Maffei, Giuseppe Presta, Roberto Perniola, Francesco Messina, Giovanna Montesano, Chiara Poggi, Lucio Giordano, Enza Roma, Carolina Grassia, Gaetano Ausanio, Fabrizio Sandri, Giovanna Mescoli, Francesco Giura, Giampaolo Garani, Agostina Solinas, Maria Lucente, Gabriella Nigro, Antonello Del Vecchio, Flavia Petrillo, Luigi Orfeo, Lidia Grappone, Lorenzo Quartulli, Antonio Scorrano, Hubert Messner, Alex Staffler, Giancarlo Gargano, Eleonora Balestri, Stefano Nobile, Caterina Cacace, Valerio Meli, Sara Dallaglio, Betta Pasqua, Loretta Mattia, Eloisa Gitto, Marcello Vitaliti, Maria Paola Re, Stefania Vedovato, Alessandra Grison, Alberto Berardi, Francesco Torcetta, Isotta Guidotti, Sandra di Fabio, Eugenia Maranella, Isabella Mondello, Stefano Visentin, Francesca Tormena
BACKGROUND: Although beneficial in clinical practice, the INtubate-SURfactant-Extubate (IN-SUR-E) method is not successful in all preterm neonates with respiratory distress syndrome, with a reported failure rate ranging from 19 to 69 %. One of the possible mechanisms responsible for the unsuccessful IN-SUR-E method, requiring subsequent re-intubation and mechanical ventilation, is the inability of the preterm lung to achieve and maintain an "optimal" functional residual capacity. The importance of lung recruitment before surfactant administration has been demonstrated in animal studies showing that recruitment leads to a more homogeneous surfactant distribution within the lungs...
August 18, 2016: Trials
https://www.readbyqxmd.com/read/27524447/novel-approaches-to-neonatal-resuscitation-and-the-impact-on-birth-asphyxia
#3
REVIEW
Arjan B Te Pas, Kristina Sobotka, Stuart B Hooper
Historically, recommendations for neonatal resuscitation were largely based on dogma, but there is renewed interest in performing resuscitation studies at birth. The emphasis for resuscitation following birth asphyxia is administering effective ventilation, as adequate lung aeration leads not only to an increase in oxygenation but also increased pulmonary blood flow and heart rate. To aerate the lung, an initial sustained inflation can increase heart rate, oxygenation, and blood pressure recovery much faster when compared with standard ventilation...
September 2016: Clinics in Perinatology
https://www.readbyqxmd.com/read/27384245/sustained-versus-intermittent-lung-inflation-for-resuscitation-of-preterm-infants-a-randomized-controlled-trial
#4
Mohamed S El-Chimi, Hisham A Awad, Tarek M El-Gammasy, Ola G El-Farghali, Mohamed T Sallam, Dina M Shinkar
AIM: To evaluate efficacy and safety of delivery room (DR) sustained lung inflation (SLI) in resuscitation of preterm neonates. METHODS: Randomized Controlled Trial including 112 preterm infants randomized to either SLI (n = 57) using T-piece resuscitator [maximum three inflations with maximum pressure of 30 cmH2O for 15 s followed by continuous positive airway pressure (CPAP) of 5-7 cmH2O] or conventional bag/mask inflation (CBMI) (n = 55) using traditional self-inflating bag (maximum pressure of 40 cmH2O at a rate of 40-60 per min)...
August 2, 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27318344/-clinical-application-of-different-recruitment-maneuvers-in-children-with-congenital-heart-disease-complicated-by-acute-respiratory-distrees-syndrome-after-surgery
#5
Hu Yalan, Guo Changying, Guo Lin, Zheng Hua, Zhang Mian
OBJECTIVE: To compare the individual effects of three recruitment maneuvers (RM) in children with congenital heart disease complicated by postoperation acute respiratory distress syndrome (ARDS). METHODS: A prospective single-blind randomized controlled trial was conducted. Thirty-two children with congenital heart disease complicated with ARDS after open-heart surgery undergoing mechanical ventilation were randomized into three groups, to whom three different RM was respectively performed, namely sustained inflation (SI), progressively increased positive end expiratory pressure (IP) and pressure control ventilation (PCV)...
December 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/27193978/effects-of-different-recruitment-maneuvers-on-bacterial-translocation-and-ventilator-induced-lung-injury
#6
Perihan Ergin Özcan, Özkan İbrahim Akıncı, İpek Edipoğlu, Evren Şentürk, Sevil Baylan, Atahan Arif Cağatay, Kemal H Türköz, Figen Esen, Lütfi Telci, Nahit Çakar
BACKGROUND: Investigated in the present study were the effects of various recruitment maneuvers (RMs) using the same inflation pressure-time product on bacterial translocation from lung to blood, and ventilator-induced lung injury (VILI). METHODS: Tracheotomy was performed on anesthetized rats, and ventilation was initiated using pressure-controlled mode. Subsequently, Pseudomonas aeruginosa was inoculated through the tracheotomy tube and ventilated for 30 minutes before rats were randomly separated into 4 groups...
March 2016: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/26991259/optimizing-lung-aeration-at-birth-using-a-sustained-inflation-and-positive-pressure-ventilation-in-preterm-rabbits
#7
Arjan B Te Pas, Marcus J Kitchen, Katie Lee, Megan J Wallace, Andreas Fouras, Robert A Lewis, Naoto Yagi, Kentaro Uesugi, Stuart B Hooper
BACKGROUND: A sustained inflation (SI) facilitates lung aeration, but the most effective pressure and duration are unknown. We investigated the effect of gestational age (GA) and airway liquid volume on the required inflation pressure and SI duration. METHODS: Rabbit kittens were delivered at 27, 29, and 30 d gestation, intubated and airway liquid was aspirated. Either no liquid (control) or 30 ml/kg of liquid was returned to the airways. Lung gas volumes were measured by plethysmography and phase-contrast X-ray-imaging...
July 2016: Pediatric Research
https://www.readbyqxmd.com/read/26923502/sustained-inflation-prophylactic-or-rescue-maneuver
#8
REVIEW
G Lista, F Cavigioli, F Castoldi, L J I Zimmermann
Application of nasal continuous positive airway pressure (nCPAP) in the delivery room is a valid alternative to mechanical ventilation in the management of respiratory failure of preterm infants, with reduced occurrence of bronchopulmonary dysplasia and death. nCPAP at birth is still burdened by a high failure rate. Sustained inflation appears to be an intriguing approach to allow the respiratory transition at birth by clearing the lung fluid, thus obtaining an adequate functional residual capacity. This may enhance nCPAP success...
June 2016: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/26866905/the-interrelationship-of-recruitment-maneuver-at-birth-antenatal-steroids-and-exogenous-surfactant-on-compliance-and-oxygenation-in-preterm-lambs
#9
David G Tingay, Anushi Rajapaksa, Karen McCall, Cornelis E E Zonneveld, Don Black, Elizabeth Perkins, Magdy Sourial, Anna Lavizzari, Peter G Davis
BACKGROUND: To describe the interrelationship between antenatal steroids, exogenous surfactant, and two approaches to lung recruitment at birth on oxygenation and respiratory system compliance (Cdyn) in preterm lambs. METHODS: Lambs (n = 63; gestational age 127 ± 1 d) received either surfactant at 10-min life (Surfactant), antenatal corticosteroids (Steroid), or neither (Control). Within each epoch lambs were randomly assigned to a 30-s 40 cmH2O sustained inflation (SI) or an initial stepwise positive end-expiratory pressure (PEEP) open lung ventilation (OLV) maneuver at birth...
June 2016: Pediatric Research
https://www.readbyqxmd.com/read/26859896/manual-ventilation-and-sustained-lung-inflation-in-an-experimental-model-influence-of-equipment-type-and-operator-s-training
#10
COMPARATIVE STUDY
Cristiane do Prado, Ruth Guinsburg, Maria Fernanda Branco de Almeida, Renata Suman Mascaretti, Luciana Assis Vale, Luciana Branco Haddad, Celso Moura Rebello
AIM: To compare the influence of devices for manual ventilation and individual experience on the applied respiratory mechanics and sustained lung inflation. METHODS: A total of 114 instructors and non-instructors from the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics participated in this study. Participants ventilated an intubated manikin. To evaluate respiratory mechanics and sustained lung inflation parameters, a direct comparison was made between the self-inflating bag and the T-shaped resuscitator (T-piece), followed by an analysis of the effectiveness of the equipment according to the participants' education and training...
2016: PloS One
https://www.readbyqxmd.com/read/26820220/sustained-lung-inflation-in-late-preterm-infants-a-randomized-controlled-trial
#11
D Mercadante, M Colnaghi, V Polimeni, E Ghezzi, M Fumagalli, D Consonni, F Mosca
OBJECTIVE: To assess the need for respiratory support in late preterm infants treated with sustained lung inflation (SLI) at birth. STUDY DESIGN: In this controlled trial, we randomly assigned infants born at 34(+0) to 36(+6) weeks of gestation to receive SLI (25 cmH2O for 15 s) at birth, followed by continuous positive airway pressure (CPAP) or assistance according to the recommendations of the American Academy of Pediatrics. The primary outcome was the need for any type of respiratory support...
June 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/26557478/recruitment-maneuvers-in-acute-respiratory-distress-syndrome-the-safe-way-is-the-best-way
#12
REVIEW
Raquel S Santos, Pedro L Silva, Paolo Pelosi, Patricia Rm Rocco
Acute respiratory distress syndrome (ARDS) represents a serious problem in critically ill patients and is associated with in-hospital mortality rates of 33%-52%. Recruitment maneuvers (RMs) are a simple, low-cost, feasible intervention that can be performed at the bedside in patients with ARDS. RMs are characterized by the application of airway pressure to increase transpulmonary pressure transiently. Once non-aerated lung units are reopened, improvements are observed in respiratory system mechanics, alveolar reaeration on computed tomography, and improvements in gas exchange (functional recruitment)...
November 4, 2015: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/26542877/respiratory-transition-in-the-newborn-a-three-phase-process
#13
REVIEW
Stuart B Hooper, Arjan B Te Pas, Marcus J Kitchen
We propose that the respiratory transition at birth passes through three distinct, but overlapping phases, which reflect different physiological states of the lung. Accordingly, respiratory support given to infants should be optimised to suit the underlying physiological state of the lung as it passes through each phase. During the first phase, the airways are liquid-filled and so no pulmonary gas exchange can occur. Respiratory support should, therefore, be focused on clearing the gas exchange regions of liquid...
May 2016: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/26527635/sustained-lung-inflation-at-birth-what-do-we-know-and-what-do-we-need-to-know
#14
REVIEW
Karen E McCall, Peter G Davis, Louise S Owen, David G Tingay
A sustained inflation has been advocated as a potential method of augmenting lung aeration at birth. Clinical trials have suggested that a sustained inflation may lead to a reduced need for intubation and ventilation in the first few days of life, without cardiovascular compromise or increased lung injury. Despite this, a sustained inflation is not currently a standard of practice, mainly due to a lack of clarity regarding the optimal delivery method. Animal trials have sought to refine delivery techniques...
March 2016: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/26493593/recruitment-maneuvers-and-peep-titration
#15
REVIEW
Dean R Hess
The injurious effects of alveolar overdistention are well accepted, and there is little debate regarding the importance of pressure and volume limitation during mechanical ventilation. The role of recruitment maneuvers is more controversial. Alveolar recruitment is desirable if it can be achieved, but the potential for recruitment is variable among patients with ARDS. A stepwise recruitment maneuver, similar to an incremental PEEP titration, is favored over sustained inflation recruitment maneuvers. Many approaches to PEEP titration have been proposed, and the best method to choose the most appropriate level for an individual patient is unclear...
November 2015: Respiratory Care
https://www.readbyqxmd.com/read/26408555/an-individualized-approach-to-sustained-inflation-duration-at-birth-improves-outcomes-in-newborn-preterm-lambs
#16
David G Tingay, Anna Lavizzari, Cornelis E E Zonneveld, Anushi Rajapaksa, Emanuela Zannin, Elizabeth Perkins, Don Black, Magdy Sourial, Raffaele L Dellacà, Fabio Mosca, Andy Adler, Bartłomiej Grychtol, Inéz Frerichs, Peter G Davis
A sustained first inflation (SI) at birth may aid lung liquid clearance and aeration, but the impact of SI duration relative to the volume-response of the lung is poorly understood. We compared three SI strategies: 1) variable duration defined by attaining volume equilibrium using real-time electrical impedance tomography (EIT; SIplat); 2) 30 s beyond equilibrium (SIlong); 3) short 30-s SI (SI30); and 4) positive pressure ventilation without SI (no-SI) on spatiotemporal aeration and ventilation (EIT), gas exchange, lung mechanics, and regional early markers of injury in preterm lambs...
November 15, 2015: American Journal of Physiology. Lung Cellular and Molecular Physiology
https://www.readbyqxmd.com/read/26406467/do-sustained-lung-inflations-during-neonatal-resuscitation-affect-cerebral-blood-volume-in-preterm-infants-a-randomized-controlled-pilot-study
#17
RANDOMIZED CONTROLLED TRIAL
Bernhard Schwaberger, Gerhard Pichler, Alexander Avian, Corinna Binder-Heschl, Nariae Baik, Berndt Urlesberger
BACKGROUND: Sustained lung inflations (SLI) during neonatal resuscitation may promote alveolar recruitment in preterm infants. While most of the studies focus on respiratory outcome, the impact of SLI on the brain hasn't been investigated yet. OBJECTIVE: Do SLI affect cerebral blood volume (CBV) in preterm infants? METHODS: Preterm infants of gestation 28 weeks 0 days to 33 weeks 6 days with requirement for respiratory support (RS) were included in this randomized controlled pilot trial...
2015: PloS One
https://www.readbyqxmd.com/read/26341533/premature-infants-born-at-25-weeks-of-gestation-may-be-compromised-by-currently-recommended-resuscitation-techniques
#18
Tereza Lamberska, Marketa Luksova, Jan Smisek, Jana Vankova, Richard Plavka
AIM: Standard resuscitation guidelines are based on data from a range of gestational ages. We sought to evaluate the effectiveness of our delivery room resuscitation protocol across a range of gestational ages in preterm infants born at <29 weeks. METHODS: We performed an observational study of prospectively collected video recordings of 73 preterm infants. The percentage of bradycardic patients, time to reach target oxygen saturation and the extent of all interventions were compared between three gestational age groups: 22-24 weeks (n = 22), 25-26 weeks (n = 27) and 27-28 weeks (n = 24)...
April 2016: Acta Paediatrica
https://www.readbyqxmd.com/read/26333431/the-effects-of-lung-recruitment-maneuvers-on-exhaled-breath-condensate-ph
#19
Brian K Walsh, Michael D Davis, John F Hunt, John N Kheir, Craig D Smallwood, John H Arnold
Exhaled breath condensate (EBC) pH serves as a surrogate marker of airway lining fluid (ALF) pH and can be used to evaluate airway acidification (AA). AA is known to be present in acute respiratory distress syndrome (ARDS) and can be evaluated via continuous EBC pH measurement during mechanical ventilation. Lung recruitment maneuvers (LRMs) are utilized in the treatment of ARDS, however, their impact on EBC pH has never been explored. Here we described the acute effects of two commonly used LRMs on EBC pH. In a prospective, non-randomized, serial exposure study, 10 intubated pediatric subjects with acute respiratory distress syndrome sequentially underwent: a period of baseline ventilation, sustained inflation (SI) maneuver of 40 cm H2O for 40 s, open lung ventilation, staircase recruitment strategy (SRS) (which involves a systematic ramping of plateau pressures in 5 cm H2O increments, starting at 30 cm H2O), and PEEP titration...
September 2015: Journal of Breath Research
https://www.readbyqxmd.com/read/26186685/spatiotemporal-aeration-and-lung-injury-patterns-are-influenced-by-the-first-inflation-strategy-at-birth
#20
David G Tingay, Anushi Rajapaksa, C Elroy Zonneveld, Don Black, Elizabeth J Perkins, Andy Adler, Bartłomiej Grychtol, Anna Lavizzari, Inéz Frerichs, Valerie A Zahra, Peter G Davis
Ineffective aeration during the first inflations at birth creates regional aeration and ventilation defects, initiating injurious pathways. This study aimed to compare a sustained first inflation at birth or dynamic end-expiratory supported recruitment during tidal inflations against ventilation without intentional recruitment on gas exchange, lung mechanics, spatiotemporal regional aeration and tidal ventilation, and regional lung injury in preterm lambs. Lambs (127 ± 2 d gestation), instrumented at birth, were ventilated for 60 minutes from birth with either lung-protective positive pressure ventilation (control) or as per control after either an initial 30 seconds of 40 cm H2O sustained inflation (SI) or an initial stepwise end-expiratory pressure recruitment maneuver during tidal inflations (duration 180 s; open lung ventilation [OLV])...
February 2016: American Journal of Respiratory Cell and Molecular Biology
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